HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
�s BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER1 ! r 0(020 ADDRESS: e—r
am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE.TIME RENEWAL and the permit shall expire should I not receive a
.passing inspectiuring any six month period during the renewal period.
Justification 'now�t—
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
;—r l Garr.
not Name
STATE OF FLORIDA
COUNTY OF S�, Ly c t t
ACKNOWLEDGED BEFORE ME THIS 3 DAY OFVaVS 20_�
BY x'11 CL (20 WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATqF FLORIDA,Colt'*of
SIGNATURE OF VTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: .
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%.open = $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/212014